Effectiveness of a Health Education Curriculum
for Secondary School Students -- United States, 1986-1989

Risk behaviors that affect the health of young persons in the
United
States include drug use, alcohol consumption, tobacco use,
imprudent
dietary patterns, physical inactivity, unsafe sexual practices, and
injury-related behaviors (1,2). Because these behaviors are usually
established during youth, since 1977 CDC has supported the
development,
evaluation, and implementation of comprehensive school health
education
curricula to reduce these behaviors among young persons. This
report
describes the impact of one of these curricula (Teenage Health
Teaching
Modules (THTM)) on student knowledge, attitudes, and selected
health-risk behaviors.

During 1979-1983, THTM was developed (3) for use at the
secondary
level initially by school systems already using the comprehensive
elementary school health education curriculum, Growing Healthy.
THTM
consists of 16 instructional modules, each of which addresses a
separate
developmentally based health task (e.g., Eating Well and Handling
Stress). Teachers are encouraged to add supplementary activities
and
materials to the module's core materials. All modules are intended
to
develop five skills: self-assessment, communication,
decision-making,
advocacy, and self-management (3).

During 1986-1989, to assess the effects of THTM on selected
student
health-risk behaviors, a large-scale controlled evaluation was
conducted
by a private research organization with technical oversight from an
external committee of health education research experts (4). The
evaluation employed a quasi-experimental pretest/posttest control
group
design (5) to determine whether selected modules of THTM could
improve
student health knowledge, attitudes, and self-reported behaviors
and to
suggest how to implement the curriculum more effectively. The
effectiveness of THTM was assessed in two settings: 1) an
"experimental"
setting, involving new users recruited for the study; and 2) a
"naturalistic" setting, involving users who had adopted THTM
independent
of the study.

Junior high/middle schools were required to use four modules
(Being
Fit, Having Friends, Living with Feelings, and Preventing Injuries)
and
senior high schools five different modules (Eating Well, Handling
Stress, Protecting Oneself and Others, Promoting Health in
Families, and
Planning a Healthy Future). Teachers in the experimental setting
were to
use all four or five required modules (and no others) and were
urged to
implement the curriculum as prescribed. Teachers in the
naturalistic
setting were to use a minimum of three of the required modules and
had
the option of using additional modules. Students were exposed to
THTM
for 36-38 45-minute classes (approximately 27 hours) during a 16-
to
18-week semester.

The evaluation included 4806 students from 149 schools in seven
states. Pretest and posttest self-administered questionnaire
responses
were analyzed for 2530 students who received THTM and 2276
same-school
controls. By education research convention, standardized effect
sizes
greater than 0.25 were considered educationally important and
further
characterized as small (0.20-0.49), moderate (0.50-0.79), and large
(greater than or equal to 0.80) (6,7). From pretest to posttest,
students in THTM-exposed classes were more likely than those in
control
classes to report larger knowledge gain scores (p less than 0.01;
2-tailed t-test) and larger attitude gain scores among senior high
school classes (p less than 0.05). The standardized effect sizes
were
moderate to large for knowledge (0.64-1.12) and moderate for
attitudes
(0.69-0.76) among senior high classes.

From pretest to posttest, THTM-exposed students in 39
experimental
senior high school classes were more likely than those in control
classes (p less than 0.05; 2-tailed t-test) to report, for the
preceding
30 days, fewer cigarettes smoked (standardized effect size: 0.47)
and
fewer instances of illegal drug use (standardized effect size:
0.58)
(Table 1).

From pretest to posttest, THTM-exposed students in 40
naturalistic
senior high school classes were more likely than those in control
classes (p less than 0.05; 2-tailed t-test) to report, for the
preceding
30 days, abstinence from cigarettes, smokeless tobacco, and illegal
drugs and fewer alcoholic drinks consumed (Table 1). The
standardized
effect sizes ranged from 0.49 to 0.65.

For senior high school classes in both experimental and
naturalistic
settings, THTM had no statistically significant effect on two other
behaviors that were measured (i.e., wearing seatbelts and eating
fried
foods). In addition, THTM had no discernible effects on any
self-reported behaviors of junior high/middle school classes.
Reported by: JG Ross, MT Errecart, Macro Systems, Inc, Silver
Spring,
Maryland. Office of Program Planning and Evaluation, Office of the
Director, Surveillance and Evaluation Research Br, Div of
Adolescent and
School Health, Center for Chronic Disease Prevention and Health
Promotion, CDC.

Editorial Note

Editorial Note: The THTM evaluation confirmed that specific modules
of a
school health education curriculum designed for secondary school
students can have educationally important effects on student
knowledge,
attitudes, and selected self-reported health-risk behaviors.
However,
the self-reports of tobacco, alcohol, and drug use were not
physiologically verified, and the limited (4-month) follow-up
period
precluded determining whether THTM had a sustained impact on
knowledge,
attitudes, and self-reported behavior. Nonetheless, these findings
support other research that suggests that carefully designed and
implemented comprehensive school health education programs can
reduce
risks for disease and injury among young persons (7,8).

Several possible explanations exist for the lack of
statistically
significant effects on the self-reported behaviors of junior
high/middle
school students; possibly the most important is that the behaviors
addressed in the modules to which these students were exposed did
not
specifically correspond with the behaviors measured in the
evaluation.

Findings from the THTM evaluation can support education and
health
professionals, parents, and other community members in achieving
the
year 2000 national health objective to "increase to at least 75
percent
the proportion of the nation's elementary and secondary schools
that
provide planned and sequential kindergarten through 12th grade
quality
school health education" (9). Because quality school health
education
can improve important health-related knowledge, attitudes, and
behaviors
for persons both during school years and in later life, health and
education agencies, parents, and other concerned community members
together should consider intensifying efforts to implement
comprehensive
school health curricula.

Public Health Service. Healthy people 2000: national health
promotion
and disease prevention objectives. Washington, DC: US Department of
Health and Human Services, Public Health Service, 1990.

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